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Cheaper alternatives to abciximab seen effective in primary PCI for MI

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Eptifibatide and tirofiban are effective alternatives to abciximab given during primary percutaneous intervention for ST-elevation MI, according to the results of a meta-analysis appearing in the American Journal of Cardiology for July 15.

Dr. Filippo Ottani, at Ospedale GB Morgagni in Forlì, Italy, and colleagues note that adjunctive treatment with the glycoprotein IIb/IIIa receptor antagonist abciximab during primary PCI for STEMI improves outcomes, but the cost of abciximab is an issue. “’Small molecule’ (SM) glycoprotein IIb/IIIa receptor antagonists, e.g., tirofiban and eptifibatide,” they write, “might represent a valid option with significant cost decrease.”

To demonstrate the noninferiority of tirofiban and eptifibatide compared to abciximab in patients with STEMI treated with primary PCI, the researchers analyzed data from 6 randomized trials and 4 registries covering more than 7000 patients.

“Overall, 4,653 received small molecules and 2,696 abciximab, and the rate of combined death and nonfatal reinfarction did not differ (4.6% vs 4.5%, odds ratio 0.99, p = 0.95) up to 30 days of follow-up,” Dr. Ottani and colleagues found.

Because the upper confidence interval point (0.8%) of the absolute difference in the rate did not cross the prespecified noninferiority limit of +1.5%, “the noninferiority of the small molecules was documented.”

The analysis also showed that major bleeding rates were also similar with small molecules (8.8%) and abciximab (6.1%) with an odds ratio of 0.92, (p=0.43).

The team concludes that results support the use of small molecule glycoprotein IIb/IIIa receptor antagonists as an alternative to abciximab in this setting. However, they note, “Although SMs are attractive because these are associated with lower cost, documentation of such efficacy is still lacking.”

Reference:

Am J Cardiol 2010;106:167–174.